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Evaluation of Primary Versus Secondary Prevention of Cervical Cancer: an evidence based literature review Jennifer Vestle, PA-S, John Carter, PhD Department of Physician Assistant College of Health Professions, Wichita, Kansas INTRODUCTION RESULTS DISCUSSION Cervical cancer is caused by Human Papillomavirus (HPV)1. Most clinicians focus solely on secondary prevention, or Pap smears. The Pap smear improves the probability of detecting cervical abnormalities at an early stage where abnormal cervical cell changes can be detected and are more easily treated. The Pap smear is a valuable tool in the secondary prevention of cervical cancer, however, most diagnoses of cervical cancer are made in women who are elderly, of low socio-economic status, and minorities. These women are less likely to receive Pap smears. The purpose of this study was to perform a systematic literature review in order to evaluate the current research to determine if primary or secondary prevention is a better strategy in preventing cervical cancer in women of all groups in order to prevent the 4900 avoidable deaths in the U.S. each year2. Pap smear screening was found to be an effective tool in decreasing the incidence of cervical cancer, however, in order to target women most at risk who do not receive Pap smears, it is not as effective as primary prevention. Therefore, primary and secondary prevention are both necessary to decrease morbidity and cervical cancer in women of all groups in the U.S. (Figure 1). Primary prevention combined with secondary prevention can help decrease the number of women diagnosed with cervical cancer each year. Each method is important in order to target every woman in the United States and not just women that have access to health care or who receive Pap smears on a regular basis. Health care providers need to encourage their patients as well as relatives, friends, and colleagues to participate in regular Pap smears and to seek treatment upon receiving abnormal results. Also important is using local and state officials to develop better screening programs and public education programs to remind women, along with adolescents, about HPV and the risk factors associated with contracting the virus. Furthermore, these education programs can promote the use of a condom to prevent contracting the virus as well as demonstrate to them that cervical cancer can be treatable when cervical changes are discovered early. METHODS To assess the efficacy between primary and secondary prevention of cervical cancer, an evidence based literature review was performed by using the Medline database from 1996 to the present date. The search was conducted using the key terms cervical cancer, Pap smear, vaginal smear, safe sex, condom use, and Human papillomavirus. Articles were selected based on various criteria. Article selection criteria included articles that were peer-reviewed in reputable journals and articles with sufficient evidence to support the conclusion. Selected studies were randomized control studies and meta-analyses. Thirteen articles met inclusion criteria and were reviewed using evidence-based methods. Primary vs. Secondary Prevention of cervical cancer Figure 1 MeSH Terms: cervical cancer, Pap smear, vaginal smear, safe sex, condom use Total articles n=13 Primary Prevention n=3 Secondary Prevention n=2 RCT n=1 RCT n=2 Neither, i.d. of risk factors n=2 Both Prevention Strategies n=5 Background n=2 CONCLUSIONS RCT n=1 Retrospective n=2 Retrospective n=4 Outcome: Primary and secondary prevention are both necessary in order to reduce morbidity and mortality of cervical cancer. Figure 2 1o vs. 2o Prevention of Cervical Cancer Results (Percent) 40 35 30 25 20 15 10 5 0 Prim . Pre v. The identification of the link between HPV and cervical cancer has resulted in more prevention strategies. Secondary prevention has proven to be an effective means of preventing cervical cancer and with increasing emphasis on primary prevention, whether through individual healthcare providers or public awareness campaigns, women of certain subgroups that once experienced inequalities in Pap smear screening can increase their probability of protecting themselves against cervical cancer. Together these two prevention strategies can help reduce the morbidity and mortality of cervical cancer in women of all groups. Se c. Pre v REFERENCES No Conclus ion Both 1 2 3 4 1. Altekruse S, Lacey J, Brinton L, Gravitt P, Silverberg S, Barnes W, Greenberg M, Hadjimichae O, McGowan L, Mortel R, Shwartz P, Hildesheim A. Comparison of human papillomavirus genotypes, sexual, reproductive risk factors of cervical adenocarcioma and squamous cell carcinoma: NE United States. AJOAG. 2003 March; 188:657-663. 2. Au WW. Lifestyle, environmental and genetic susceptibility to cervical cancer. Toxicology. 2004 May; 198(1-3):117-120.